This Draft Standard for Trial Use contains the format and establishes the data contents of the Benefit Enrollment and Maintenance Transaction Set (834) to be used within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to establish communication between the sponsor of the insurance product and the payer. Such transaction(s) may or may not take place through a third party administrator (TPA).
For the purpose of this standard, the sponsor is the party or entity that ultimately pays for the coverage, benefit or product. A sponsor can be an employer, union, government agency, association, or insurance agency.
The payer refers to an entity that pays claims, administers the insurance product or benefit, or both. A payer can be an insurance company, health maintenance organization (HMO), preferred provider organization (PPO), government agency (Medicare, Medicaid, Champus, etc.), or an entity that may be contracted by one of these former groups.
For the purpose of the 834 transaction set, a third party administrator (TPA) can be contracted by a sponsor to handle data gathering from those covered by the sponsor if the sponsor does not elect to perform this function itself.
To indicate the start of a transaction set and to assign a control number
To indicate the beginning of a transaction set.
To specify identifying numbers.
To specify any or all of a date, a time, or a time period
To indicate the total monetary amount.
To specify quantity information.
To identify a party by type of organization, name and code
To specify additional names or those longer than 35 characters in length
To specify the location of the named party
To specify the geographic place of the named party
To identify a person or office to whom administrative communications should be directed
To specify account information.
To specify identifying numbers.
To specify the location of the named party
To specify the geographic place of the named party
To identify a person or office to whom administrative communications should be directed
To specify any or all of a date, a time, or a time period
To indicate the total monetary amount.
To provide benefit information on insured entities
To specify identifying numbers.
To supply the full name of an individual or organizational entity
To specify any or all of a date, a time, or a time period
To specify the location of the named party
To specify the geographic place of the named party
To supply demographic information
To supply information on the electronic funds transfer (EFT) method of payment
To provide class of employment information
To supply information to determine benefit eligibility, deductibles and retirement and investment contributions
To indicate the total monetary amount.
To provide health information
To provide characteristics that may have multiple values
To identify a party by type of organization, name and code
To specify any or all of a date, a time, or a time period
To specify the location of the named party
To specify the geographic place of the named party
To supply disability information
To specify any or all of a date, a time, or a time period
To specify the characteristics of an adjustment
To identify a person or office to whom administrative communications should be directed
To specify the location of the named party
To specify the geographic place of the named party
To provide information on health coverage
To specify any or all of a date, a time, or a time period
To indicate the total monetary amount.
To specify identifying numbers.
To provide notification to produce replacement identification card
To reference a line number in a transaction set.
To supply the full name of an individual or organizational entity
To identify a party by type of organization, name and code
To specify additional names or those longer than 35 characters in length
To specify the location of the named party
To specify the geographic place of the named party
To identify a person or office to whom administrative communications should be directed
To specify the identifying characteristics of a provider
To specify any or all of a date, a time, or a time period
To supply information on coordination of benefits
To identify a party by type of organization, name and code
To specify additional names or those longer than 35 characters in length
To specify the location of the named party
To specify the geographic place of the named party
To specify any or all of a date, a time, or a time period
To provide information on life coverage
To indicate the total monetary amount.
To specify any or all of a date, a time, or a time period
To supply beneficiary information
To supply the full name of an individual or organizational entity
To identify a party by type of organization, name and code
To specify additional names or those longer than 35 characters in length
To specify the location of the named party
To specify the geographic place of the named party
To supply demographic information
To supply flexible spending account information
To indicate the total monetary amount.
To specify any or all of a date, a time, or a time period
To specify the retirement product characteristics
To specify any or all of a date, a time, or a time period
To specify identifying numbers.
To specify type of investment vehicle or account and other basic data about the investment
To supply beneficiary information
To supply the full name of an individual or organizational entity
To identify a party by type of organization, name and code
To specify additional names or those longer than 35 characters in length
To specify the location of the named party
To specify the geographic place of the named party
To supply demographic information
To specify the financial contribution information
To specify any or all of a date, a time, or a time period
To specify type of investment vehicle or account and other basic data about the investment
To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments).
